Post written by Shelini Sooklal, MD, and Anand Kumar, MD, MPH, from the Division of Gastroenterology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.

Our video case describes the implementation of a therapeutic endoscopic ultrasound
(EUS) technique to provide palliative relief of recurrent small bowel obstruction in a patient with metastatic adenocarcinoma of the colon with extensive peritoneal carcinomatosis. An enterocolostomy was created with the use of EUS-guided lumen apposing metal stent placement from the duodenum to the ascending colon, thereby bypassing the obstructed small bowel. The patient had swift relief of symptoms and was not readmitted with recurrent bowel obstruction.

Caring for end-of-life patients with recurrent bowel obstructions due to peritoneal carcinomatosis can be difficult when traditional endoscopic or interventional radiology or surgical techniques are not feasible. Enterocolostomy using a lumen apposing metal stent has not been widely described in the endoscopic literature, and we believe that endoscopists may consider using this treatment modality in carefully selected patients.

When conventional treatment options have been exhausted, we applied existing technology in a novel treatment option that provided relief for this highly symptomatic patient. This case is also a good example of the ever-evolving role of therapeutic EUS in the management of complex patients.

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